tbuckley/cabot-search huggingface dataset:
Abstract 11724: Echocardiographic Predictors and Outcomes of Multiple Vegetations in Infective Endocarditis
Authors: Ajay K Mishra, Ibragim Al-Seykal, Pradnya Brijmohan B Bhattad, Nitish Sharma, Anu Anna George, Jen Sargent, Mark Kranis
Journal: Circulation (2022)

Introduction: Infective endocarditis (IE) is a life-threatening infection with an annual mortality of 40%. Embolic events reported in up to 80% of patients. Vegetations of &gt; 10 mm size are associated with increased embolic events and poor prognosis. There is a paucity of literature on the association of multiple vegetations with outcomeHypothesis: We aimed to study the echocardiographic (ECHO) features and outcomes associated with the presence of multiple vegetationsMethods: In this retrospective, single-center, case-control study patients diagnosed with IE were recruited from June 2017 to June 2019. A total of 84 patients were diagnosed to have IE, of whom 67 with vegetation were identified. Baseline demographic, clinical, laboratory, and ECHO parameters were reviewed. Outcomes that were studied included recurrent admission, embolic phenomenon, and mortality. Results: Twenty-three (34%) patients were noted to have multiple vegetations, 13 (56.5 %) were male and 10 (43.5%) were female. The mean age of these patients was 50. Eight (35%) had a prior episode of IE. ECHO features of moderate to severe valvular regurgitation (OR:4), presence of pacemaker lead (OR:4.8), impaired LV relaxation, (OR:4), and elevated PASP (OR:2.2) are associated with higher odds of multiple vegetations. Of these moderate to severe valvular regurgitation (p: 0.028), pacemaker lead (p-0.039) and impaired relaxation (p-0.028) were statistically significant. These patients were noted to have an increased association of recurrent admissions (OR:3.6), recurrent bacteremia (OR:2.4), embolic phenomenon (OR:2.5), ICU stay (OR:2.8), hypotension (OR:2.1), surgical intervention (OR:2.8) and device removal (OR:4.8). Of this device removal (p-0.039) and recurrent admissions (0.017) were statistically significantConclusions: This study highlights the associations of echocardiographic predictors and outcomes in patients with IE having multiple vegetations. ECHO features of moderate to severe regurgitation, presence of pacemaker lead, impaired LV relaxation, and elevated PASP and outcomes including recurrent admissions and device removal were found to be associated with multiple vegetations
Abstract 11486: Hormone-Independent Sex Dimorphisms in Cardiac Reparative Functions of Bone Marrow Stem Cells: Underlying Epigenetic Insights
Authors: Charan T Gurrala, Zhongjian A Cheng, Vandana Mallaredy, Maria Cimini, Darukeshwara Joladarashi, May Truongcao, Chunlin Wang, Anna Maria Lucchese, Grace Huang, Carolina Gonzalez, Ajit Magadum, Rajika Roy, Jayashri Ghosh, Cindy Benedict, Walter J Koch, Raj Kishore
Journal: Circulation (2022)

Introduction: This work was designed to identify the hormone-independent mechanisms that govern the superiority of female endothelial progenitor cells (F-EPC) for cardiac repair post myocardial infarction (MI). A direct comparison of therapeutic efficacy of gender-specific stem cells or estrogen-independent mechanisms of gender-specific dimorphism in the reparative properties of EPCs has not been established. Hypothesis: We hypothesized that epigenetic mechanisms contribute to the sex-specific functional dimorphisms of Sca-1+/CD31+ EPCs in regulating cardiac reparative functions post-MI. Methods: Male (M), female (F), and ovariectomized (OVX) mice derived Sca-1+/CD31+ EPCs were subjected through a series of cytokine quantifications and epigenetic CUT&amp;Tag screening, followed by assessment of their therapeutic function in vitro and in vivo . Results: F-EPC and OVX EPC secrete high levels of proangiogenic factors and low amounts of pro-inflammatory cytokines compared to M-EPC. Further evaluation of the inflammasome showed that the M-EPC secreted the most elevated amounts of CCL3, and other inflammatory chemokines compared to F-EPC and OVX EPC. The secretome of F-EPC and OVX EPC was found to be substantially proangiogenic in vitro than the male EPCs. Post-MI injection of F-EPC and OVX EPC resulted in remarkable preservation of cardiac structure and functions. In contrast, post-MI injection of M-EPC resulted in an inflamed myocardium. Epigenetic sequencing of the sex differential EPCs for the H3K9me3 mark showed high methylation in M-EPC compared to F-EPC and OVX EPC. The inhibition of histone methyltransferase, G9a using BIX-01294 upregulated the secretion of inflammatory factors in all EPCs. The conditioned medium from all EPCs with high levels of CCL3 inhibited angiogenesis in vitro . Neutralizing CCL3 in the same medium restored in vitro angiogenesis. Conclusion: EPCs from both fertile and OVX female mice retain better cardiac reparative activity than their male counterparts irrespective of sex hormone influence. Mechanistically, we show that this gender-based functional dimorphism of EPCs is mediated, in part, by differential epigenetic regulation of chemokine CCL3.
Abstract 11244: Active Decompression During Device Assisted Elevation of the Head and Thorax, an Impedance Threshold Device, and Active Compression Decompression Cardiopulmonary Resuscitation is Needed for Sustained Hemodynamic Benefit in a Porcine Model of Prolonged Cardiac Arrest
Authors: Susana Arango, Shilpa Kshatriya, Anja Metzger, Bayert Salverda, Michael Lick, Johanna C Moore, Keith G Lurie
Journal: Circulation (2022)

Introduction: Active compression decompression cardiopulmonary resuscitation (CPR), an impedance threshold device (ITD), and automated device-assisted controlled head up positioning, collectively termed AHUP CPR, work synergistically to lower intracranial pressure, augment venous return to the heart and significantly improve neurological survival versus conventional (C)-CPR in animals and patients in cardiac arrest. The current study focused on the role of active decompression (AD) during prolonged AHUP CPR, since AD can be difficult to perform manually for an extended period. Hypothesis: Full AD is needed to optimize hemodynamics during prolonged AHUP CPR Methods: Six female and male farm pigs (~40 kg) were sedated, intubated, anesthetized, and monitored. After 8 min of untreated ventricular fibrillation followed by ≥ 30 min of AHUP CPR with an automated device, AHUP CPR was continued except that AD was intentionally reduced from an average of 3.33 ± 0.37 cm of lift to 0 cm lift above the resting neutral position as this is the amount of decompression that occurs with C-CPR and passive chest wall recoil. After 1 min of AHUP CPR with 0 cm lift, AD was progressively increased back to 3 cm of lift over 3 min. Hemodynamics (mean ± SD) were compared using Student’s t test, where p&lt;0.05 was considered statistically significant. Results Coronary perfusion pressure (CorPP) (p&lt;0.005), cerebral perfusion pressure (CerPP) (p&lt;0.001), and ETCO2 (p&lt;0.0001) significantly decreased after AD was discontinued (Fig.1). With restoration of AD to 3 cm, CorPP (p&lt;0.009) and ETCO2 (p&lt;0.001) significantly improved and CerPP trended higher (p=0.084). Conclusion During prolonged (≥ 30 min) AHUP CPR in pigs, active lift of the chest wall is essential to maintain stable hemodynamics. Hemodynamics deteriorated rapidly with intentional loss of AD, but could be partially restored with resumption of AD.
Abstract 12446: Effectiveness of a Digital Health Enabled Cardiac Rehabilitation Program in Reducing Recurrent Events For Private Health Insurance Patients in Australia
Authors: Justin P Braver, Stephanie R Yiallourou, Agus Salim, Catherine Keating, Melinda J Carrington
Journal: Circulation (2022)

Introduction: Secondary prevention programs are paramount to avoid cardiovascular disease morbidity and mortality. However, they are underutilized. Technology-enabled programs provide a new frontier to break down access barriers and enhance health service delivery. We implemented a telehealth program using a cardiac rehabilitation (CR) mobile app for privately insured patients following a hospitalization for coronary heart disease. Hypothesis: It was hypothesized that patients participating in a digitally-enabled CR program would have improved health behaviors and less recurrent events at 30-days to 12-months post discharge compared with propensity matched controls. Methods: Eligible patients received the Smart-CR mobile app, supplemented with telehealth consultations. Clinical and lifestyle changes, psychological well-being, quality of life and medication adherence were assessed at the beginning and 8-weeks following participation in the program. Using propensity matching methods, we compared rehospitalization and mortality rates of the digital-CR group (n=160) with a traditionally delivered CR group (n=115) and patients who did not undertake any form of CR (n=266). Results: Among 160 patients (35% regional/remote, 70% male and 78% aged over 60 years), physical activity levels increased from 128 minutes/week to 300 minutes/week and systolic blood pressure decreased by 5 mmHg. There were improvements in most other clinical, behavioral and lifestyle risk factors, including functional capacity, depression, anxiety, and quality of life. At 60 days, digital-CR reduced cardiac-related readmissions by 52% (RR 0.48; 95% CI: 0.24 to 0.93) compared to no CR. At 90 days, traditional CR decreased all cause readmissions by 36% (RR 0.64; 95% CI: 0.44 to 0.94) compared to non-attendance to CR. There were no other pairwise differences between groups at 30, 60 or 90 days. Health economic analyses and extended outcomes to 12 months post hospitalization are in process. Conclusion: A remotely delivered, technology-enabled CR program was effective in reducing hospital readmissions and improving cardiovascular risk. A randomized controlled trial is underway to test the generalizability of these findings in community participants.
Abstract 12162: Acute Myocardial Infarction Caused by Spontaneous Coronary Artery Dissection of the First Septal Perforator
Authors: Josh Rezkalla, Philip A Araoz, Gurpreet Singh, Marysia Tweet
Journal: Circulation (2022)

A 68 year old female with hyperlipidemia and tobacco use presented with acute, substernal, chest pressure that occurred during yard work. She had no prior history of coronary artery disease or stable angina. Electrocardiograms (ECG) did not have ischemic changes but high sensitivity troponin was elevated at 285 ng/L and peaked at 1308 ng/L. Therapy was started for acute coronary syndrome and nitroglycerin drip for continued discomfort. Echocardiogram showed ejection fraction of 61% and akinesis of the infero-septum at the mid-ventricle. Coronary angiogram showed diffuse narrowing of the large first septal branch artery (S1) concerning for coronary intramural hematoma. No other significant coronary artery disease was present. Cardiac magnetic resonance (CMR) confirmed hypokinesis of the septum and subendocardial delayed enhancement in the interventricular septum at the mid ventricle suggestive of an isolated septal perforator infarct. She was conservatively managed and discharged 48 hours later. Four days later she had recurrent chest pressure and was re-admitted. Her ECG showed J-point elevation in the anteroseptal leads. Repeat coronary angiogram showed unchanged type 2 spontaneous coronary artery dissection of S1 and a small coronary cameral fistula between the distal septal branch and the right ventricle. The diagnosis of spontaneous coronary artery dissection of the first septal branch is rare and may be missed on angiogram. CMR in addition to invasive coronary angiography aides in the evaluation of this rare cause of acute myocardial infarction and changes clinical management decisions including observation time and evaluation for fibromuscular dysplasia.
Abstract 11584: Systemic Inflammation and Coronary Plaque Among Asymptomatic US Adults - Insights From the Miami Heart Study at Baptist Health South Florida
Authors: Shubham Lahan, Miguel Cainzos Achirica, Javier Valero Elizondo, Shozab S Ali, Lara Arias, Anshul Saxena, Theodore Feldman, Michael J Blaha, Michael D Shapiro, Ron Blankstein, Garima Sharma, Ricardo C Cury, Matthew Budoff, Jonathan Fialkow, Khurram Nasir
Journal: Circulation (2022)

Objective: We aimed to evaluate the association between inflammatory markers and coronary plaque as detected on coronary computed tomography angiography (CCTA) in an asymptomatic adult population. Methods: Data from Miami Heart Study — an ongoing prospective cohort study from the Greater Miami Area were used for this cross-sectional analysis. Exposures of interest were C-reactive protein (CRP; &lt;2 vs ≥ 2mg/L) and Interleukin-6 (IL-6; in tertiles). The outcomes of interest were CCTA-based plaque findings: any plaque, CAC&gt;0, CAC&gt;100, maximal stenosis &gt;50%, and high-risk plaque. Multivariable logistic regression models were constructed to evaluate the association between inflammatory markers and coronary plaque features. Results: We evaluated 2,359 patients (50.4% men), mean age 53.4±6.7 years. The largest racial/ethnic groups were Hispanics (47%) and non-Hispanic Whites (43.1%). Of the total cohort, 8.3% had diabetes, 56.2% were hypertensive, and 22.3% used statins. After adjusting for age, sex, race/ethnicity, CRP ≥2 mg/L was associated with increased odds of detection of any plaque on CCTA [odds ratio (OR), 1.31 (95% CI, 1.09-1.58)] and stenosis ≥ 50% [OR, 1.69 (95% CI, 1.18- 2.41)]. Likewise, IL-6 levels in 3 rd tertile had higher odds of detecting any plaque and ≥50% stenosis by 1.6 and 2.5 folds, respectively ( Figure ); and were also associated with a CAC &gt;100 [OR, 1.69 (95% CI, 1.09 - 2.61)]. Further adjustment for LDL-C, diabetes, and tobacco use attenuated these associations. In contrast, no significant associations were observed with having high-risk coronary plaque. Conclusions: Elevated levels of CRP and IL-6 are associated with presence of coronary plaque &amp; stenosis on CCTA adjusted for demographics. However, these associations are markedly attenuated when adjusted for additional cardiovascular risk factors. Our findings suggest a role of systemic inflammation as a mediator of the effect of cardiovascular risk factors on coronary plaque burden.
Abstract 11420: A Subgroup Meta-Analysis Comparing the Renal Denervation Sham Controlled Randomized Trials Among Those With Resistant and Nonresistant Hypertension
Authors: Mohammad Ahmed, Matthew Nudy, Rahul Bussa, Andrew Foy
Journal: Circulation (2022)

Introduction: Renal denervation (RD) has been investigated as an invasive blood pressure (BP) lowering treatment for hypertension (HTN). Resistant HTN (RHTN) has been defined as uncontrolled BP despite use of 3 antihypertensive medications of different classes, including a diuretic, at maximum tolerated doses. The impact RD on RHTN remains under investigation. Methods: Ten sham-controlled trials testing RD were included in this trial-level analysis. A prespecified subgroup analysis was conducted to test whether efficacy of RD differed in patients with and without RHTN. The primary endpoints were change in 24-hour ambulatory systolic (SBP) and diastolic (DBP) using raw mean difference (RMD) between sham control and RD. Results: Ten studies (6 RHTN and 4 nonresistant HTN) were identified that included 1,544 participants (1,001 RHTN and 543 essential HTN) with cumulative mean age (±SD) of 56 (±11) years. Cochran risk of bias assessment showed 88% of the domains to be low risk of bias for the RHTN studies and 92% of the domains to be low risk of bias for the nonresistant HTN studies. The RMD for 24-hourr SBP between RD and sham-control was statistically significant for nonresistant HTN trials (-4.19 mmHg; 95% CI -6.07 to -2.30) but was not statistically significant for RHTN trials (-1.86 mmHg; 95% CI - 3.89 to 0.16). Despite the numerical difference in the subgroups, the interaction between subgroups failed to reach statistical significance (p = 0.10). The RMD for 24-hour DBP between RD and sham-control was statistically significant for nonresistant HTN trials (-2.60 mmHg; 95% CI -3.79 to -1.42) but was not statistically significant for RHTN trials (-0.67 mmHg; 95% CI -1.84 to 0.50). The interaction between subgroups was statistically significant (p = 0.02). Discussion: Our analysis indicates RD does not seem to be an efficacious intervention for patients with RHTN. This data may be beneficial for clinicians to consider when assessing patients with RHTN for RD.
Abstract 11293: Atrial Fibrillation Associated With Ivabradine: An Analysis of FDA Adverse Events Reporting System Database
Authors: Javaria Ahmad, Hassaan Ali A Ahmad, Paari Dominic
Journal: Circulation (2022)

Introduction: Ivabradine has been shown to be associated with atrial fibrillation (AF) in a metanalysis of 11 studies, however, AF has not been routinely reported as an adverse event of ivabradine in clinical trials. The FDA Adverse Event Reporting System (FAERS) is a publicly available database of adverse events (AE) of various drugs. We analyzed the database for real-world AF reporting with Ivabradine. Methods: FAERS was searched for the adverse events reported for ivabradine. All AF cases were individually analyzed. Results: A total of 3550 AE reports of Ivabradine were reported to FAERS from April 2011 to August 2021 out of which 1117 were cardiac adverse events. A total of 78 cases of AF were reported, accounting for 2.1% of the total AE reports and 31% of cardiac AE reports. Sex was reported in 83% of total AF cases, of which 50% were male, and the other 50% were female. 79% of the AF cases were reported by health care professionals, and 21% by consumers. 51% of cases were reported from the United States, 10% from France, and 9% from Germany. In 51% of the cases, no concomitant drug was given with ivabradine, and in 49% a concomitant drug was given; 10% of those was Digoxin/Digitalis that has been associated with AF. When searched using OpenVigilFDA (a web-based user interface to the FAERS for extraction and analysis of adverse events reports), the reporting odds ratio (ROR) of Ivabradine for AF was 3.18 (95% CI: 2.46 - 4.10) and the proportional reporting ratio was 3.15. The comparison of RORs of ivabradine with the drugs traditionally known to cause AF is shown in the figure. Conclusions: Disproportionate reporting of AF with ivabradine indicates that AF is associated with Ivabradine use. Further studies are required to confirm this association
Abstract 11579: Clopidogrel Monotherapy Associates With Increased Mortality Compared With Aspirin Independently of Cardiometabolic Risk Factors
Authors: Rohin K Reddy, Brian X. Wang, Bethany Gwyther, Turja Chakraborty, Balaji Gothandaraman
Journal: Circulation (2022)

Introduction: Antiplatelet monotherapy is recommended for prevention of ischaemic events and death following acute coronary syndrome, particularly if contraindications preclude the use of dual antiplatelet therapy. We aimed to scrutinise the effects of clopidogrel vs aspirin when given as secondary prevention monotherapy on mortality independent of baseline cardiometabolic risk factors in a large real-world UK cohort. Methods: Between 2012 and 2017, consecutive patients (n = 12967) discharged on clopidogrel or aspirin monotherapy were enrolled at our institution in London, UK (median follow-up 244 days, IQR 659). The primary endpoint was all-cause mortality. Kaplan-Meier curves with a log rank test were used to compare all-cause mortality between patients discharged on clopidogrel monotherapy vs aspirin monotherapy. Cox proportional hazards models were constructed to investigate the relationship between antiplatelet monotherapy and all-cause mortality in multivariable analyses. Results: Overall, the primary endpoint of all-cause mortality occurred in 2585 (19.9%) patients: 1642 (18.3%) in the aspirin monotherapy group, compared with 943 (23.5%) on clopidogrel monotherapy (log rank p &lt; 0.001), depicted in Figure 1. Clopidogrel monotherapy conferred an 16% increased risk of mortality compared with aspirin in the unadjusted Cox model (HR 1.16, 95% CI 1.07 - 1.25, p &lt; 0.001). Following adjustment for age, ischaemic heart disease, stroke hypertension, heart failure, atrial fibrillation, diabetes mellitus, chronic kidney disease and chronic obstructive pulmonary disease, clopidogrel remained significantly associated with increased mortality (HR 1.09, 95% CI 1.00 - 1.18, p = 0.045). Conclusions: In this large UK cohort, clopidogrel monotherapy associated with increased all-cause mortality compared with aspirin independently of common cardiometabolic comorbidities.
Abstract 12195: Accurate Detection of Lead Malfunction Based on Ekg-Derived Bipolar Pacing Stimulus Amplitude
Authors: Mary Pelling, Rand Ibrahim, Mikhael F El-Chami, Michael S Lloyd
Journal: Circulation (2022)

Introduction: The increasing prevalence of pacemaker lead noise indicating insulation breach has previously been described. Unfortunately, early detection is neither predictable nor accurate by traditional measurements. “Pseudo-unipolarization” of bipolar pacing stimuli as observed from routine 12-lead EKG due to current leak holds promise as a means of detecting insulation breaches. We sought to characterize this EKG finding to better detect lead malfunction. Methods: 138 patients who received transvenous lead implantations with pacing noted on EKG at time of implant (control group, n=50) or after time of known malfunction (malfunction group, n=88) were included. The highest amplitude (any of 12-leads on standard EKG, 10mm/mV, GE Marquette) of the bipolar pacing stimulus on EKG was recorded. Chi-squared analysis was used to compare categorical variables and independent t-test was applied for continuous values. An ROC curve for maximum EKG bipolar pacing stimulus amplitude was generated for prediction of lead functional status (normal versus malfunction). Results: The cohort (49% females, 34% non-white) had an average age of 67 ± 16 years at implant. Malfunction was chiefly identified by lead noise on routine interrogation, consisting of 61% RA and 39% RV leads with mean pacing output 2.74V at 0.5ms. Mean time to malfunction was 6 ± 4 years post implant. There was significant difference in EKG bipolar stimulus amplitudes at time of failure (15.06 ± 13.533mm, p&lt;0.01) compared to those of normal leads (mean=2.54 ± 1.265mm), but no significant difference in pacing output. ROC curve for the prediction of lead malfunction based on EKG amplitude displayed area under curve=0.93 (95% CI [0.891, 0.969]). Selecting an EKG stimulus amplitude cut-off at 3.5mm for the prediction of lead malfunction demonstrated a sensitivity of 86.4% and a specificity of 76%. Conclusion: The amplitude of a bipolar pacing stimulus on EKG is significantly different among normal functioning leads and those with known malfunction due to insulation breach. We found reasonably good performance of this derived measure at distinguishing among the two groups using a cutoff of 3.5mm for EKG stimulus amplitude. A larger prospective dataset is needed to validate a reliable threshold point.